HK1174571B - Combination therapy for copd - Google Patents

Description

Combination therapy for COPD

Technical Field

The present invention relates to a pharmaceutical aerosol solution intended for use with a pressurised metered dose inhaler comprising glycopyrronium chloride and formoterol or a salt thereof. The invention also relates to the use of such formulations in the prevention and treatment of respiratory disorders (respiratory disorders), including COPD.

Background

Glycopyrrolate (also known as glycopyrrolate) is a muscarinic M3 anticholinergic agent used to reduce salivary secretion associated with the administration of some narcotics and as an adjunct therapy for peptic ulcer disease. It has also been reported to be effective in treating asthma symptoms (Hansel et al, Chest 2005;128: 1974-.

WO 2005/107873 relates to the use of glycopyrrolate in the treatment of childhood asthma.

WO 01/76575 discloses a controlled release formulation for pulmonary delivery of glycopyrrolate. The formulation is intended for use in respiratory diseases, in particular Chronic Obstructive Pulmonary Disease (COPD). The present application focuses on dry powder formulations suitable for delivery by a Dry Powder Inhaler (DPI).

WO 2005/074918 discloses combinations of glycopyrrolate with glucocorticoid medicaments and their use in the treatment of respiratory diseases.

WO 2005/110402 relates to combinations of glycopyrrolate with beta-2 agonists of the indane or benzothiazol-2-one derivatives for the treatment of inflammatory or obstructive airways diseases.

WO 2006/105401 relates to a combination of an anticholinergic, a corticosteroid and a long-acting beta-2 agonist for the prevention and treatment of respiratory, inflammatory or obstructive airways diseases. The anticholinergic is glycopyrrolate.

According to WO 2007/057223 and WO 2007/057222 glycopyrrolate in combination with anti-inflammatory steroids and in particular mometasone furoate, respectively, provides therapeutic benefits for the treatment of inflammatory and obstructive airways diseases.

WO 2007/057221 and WO 2007/057219 relate to combinations of glycopyrrolate (glycopyrronium) salts with indanyl derivative beta-2 agonists (or analogues) and, correspondingly, with anti-inflammatory steroids and, in particular, mometasone furoate.

As possible alternatives to the bromide counter ion of the glycopyrrolate, other counter ions (including in particular chloride) have been cited. WO 2006/100453 proposes the use of iodides, acetates and sulfates as an alternative to glycopyrronium bromide, due to the milling difficulties associated with the latter.

Until the disclosure of this specification, no evidence has been published that glycopyrronium chloride is clinically effective or can be formulated in a manner suitable for administration to patients with respiratory disease. The inventors have observed that glycopyrronium chloride has several advantages over glycopyrronium bromide in terms of pharmaceutical formulation. In particular, glycopyrronium chloride has a solubility profile which is superior to that of glycopyrronium bromide and has also been found to have a better compatibility with other active ingredients, in particular with formoterol.

Formoterol is a beta-2 agonist capable of relaxing bronchial smooth muscle and opening the airways to alleviate wheezing disorders. It is commonly used to control asthma and other respiratory diseases.

Recently effective combination therapies comprising formoterol fumarate and beclometasone dipropionate (corticosteroids) have become available under the trade nameThe following was obtained. Design ofFor delivery by aerosol to the lungs using a pressurized metered dose inhaler (pMDI). Aerosol solutions of formoterol fumarate have long been known to be relatively unstable and have a short shelf life when stored under sub-optimal conditions.The formulations incorporate an amount of a mineral acid to stabilize the formoterol formulation (as described in EP 1157689).

It would be desirable to provide a clinically useful combination aerosol product that combines the therapeutic benefits of formoterol and glycopyrronium chloride, optionally with beclomethasone dipropionate. Such products may need to be formulated in such a way that each pharmaceutically active ingredient is delivered to the lungs in an effective and consistent dose over an extended product lifetime, and ideally without the need for storage under specialized temperature or humidity conditions.

Disclosure of Invention

The present invention provides a pharmaceutical aerosol formulation comprising, dissolved in an HFA propellant and a co-solvent:

(a) glycopyrronium chloride; and

(b) formoterol or a salt thereof;

wherein the formulation further comprises an inorganic acid as a stabilizer. Optionally, the formulation further comprises beclomethasone dipropionate.

In another aspect, the invention provides the use of a combination product comprising glycopyrronium chloride and formoterol or a salt thereof in the prevention or treatment of COPD and other respiratory disorders.

In another aspect, the invention provides a canister (canisterer) for use with a pMDI comprising, dissolved in a mixture of HFA propellant and co-solvent:

(a) glycopyrronium chloride; and

(b) formoterol or a salt thereof;

wherein the formulation further comprises an inorganic acid as a stabilizer.

Detailed Description

When attempting to formulate a combination solution product comprising glycopyrronium chloride and formoterol, it has been unexpectedly found that the formoterol component undergoes significant degradation upon storage under conditions of elevated temperature and relative humidity to a degree that is not clinically and commercially feasible. This is true despite the presence of an acid in the formulation which is generally sufficient to stabilize the formoterol component.

Glycopyrronium chloride has also been found to be generally unstable in formulations based on HFA and co-solvents in aerosol solutions, but stable in the presence of acids in the formulation.

Upon further analysis, it was shown that the formoterol component was degraded to a range of different products in the presence of glycopyrronium chloride. Under sub-optimal conditions, the amount of these degradation products may exceed the identification and specification reporting thresholds for new pharmaceutical products (as defined in ICH GuidelineQ3B (R2)). Thus, it is clear that there is a need to modify the formulation to improve formoterol stability and to reduce the level of unwanted degradation products.

Subsequent experiments have revealed that a successful means of avoiding these stability problems is to include an optimum amount of acid in the formulation so that the formoterol and glycopyrronium chloride components remain stable. In particular, the inventors have found that 1M HCl in an amount of 0.1 to 0.3. mu.g/. mu.l, preferably 0.15 to 0.28. mu.g/. mu.l, more preferably 0.18 to 0.26. mu.g/. mu.l, even more preferably 0.20 to 0.23. mu.g/. mu.l, in solution is sufficient to facilitate the stability of glycopyrronium chloride and formoterol over extended non-optimal shelf-life, thereby ensuring consistent doses of glycopyrronium chloride and formoterol each actuation (actuation) of a pMDI containing formulation of the solution. The amount of acid included in the formulation is conveniently determined by the amount of acid added rather than the resulting pH, as the latter is difficult to determine in non-aqueous systems, such as propellant-based solutions.

Another significant finding was that the removal of oxygen from the headspace of the canister further stabilized formoterol at all tested concentrations of 1M HCl.

Glycopyrronium chloride, chemically defined as 3- [ (cyclopentylhydroxyphenylacetyl) oxy ] -1, 1-dimethylpyrrolidinium chloride, has two chiral centers, corresponding to 4 potentially different stereoisomers having the configurations (3R,2'R) -, (3S,2' R) -, (3R,2'S) -, and (3S,2' S) -. Glycopyrronium chloride in the form of any of these pure enantiomers or diastereomers, or any combination thereof, may be used in the practice of the present invention. In one embodiment of the present invention, racemic mixtures of (3S,2'R), (3R,2' S) -3- [ (cyclopentylhydroxyphenylacetyl) oxy ] -1, 1-dimethylpyrrolidinium chloride are preferred. Glycopyrronium chloride is present in the formulation in an amount of 0.005-0.83% (w/w), preferably 0.010-0.13% (w/w), more preferably 0.015-0.04% (w/w), wherein% (w/w) refers to the amount of the ingredient by weight expressed as a percentage relative to the total weight of the composition.

Glycopyrronium chloride can be prepared using any suitable synthetic technique, such as that described in a co-pending application filed by Chiesi Farmaceuti SpA.

The propellant component of the composition may be any pressure liquefied propellant and is preferably a Hydrofluoroalkane (HFA) or a mixture of different HFAs, more preferably selected from HFA134a (1,1,1, 2-tetrafluoroethane), HFA 227(1,1,1,2,3,3, 3-heptafluoropropane and mixtures thereof the preferred HFA is HFA134a (1,1,1, 2-tetrafluoroethane) the HFAs may be present in the formulation in an amount of 75-95% (w/w), preferably 85-90% (w/w).

The formoterol component of the formulation may be in the form of the free base, salt or solvate. Formoterol is preferably provided in the form of formoterol fumarate. For example, formoterol can be used in the formulation in an amount of 0.005-0.07% w/w, preferably 0.01-0.02% w/w.

The co-solvent incorporated in the formulations of the invention has a polarity higher than that of the propellant and may include one or more substances such as pharmaceutically acceptable alcohols, particularly ethanol; or polyols, such as propylene glycol or polyethylene glycol.

Advantageously, the co-solvent is selected from lower branched or straight chain alkyl (C1-C4) alcohols, such as ethanol and isopropanol. Preferably the co-solvent is ethanol.

The concentration of the co-solvent will vary depending on the final concentration of the active ingredient in the formulation and the type of propellant. For example, ethanol may be used at a concentration of 5-25% (w/w), preferably 8-20% (w/w), more preferably 10-15% (w/w). In a preferred embodiment, the concentration of ethanol is 12% (w/w).

The ratio of propellant to co-solvent in the formulation is preferably in the range 50:50 to 95:5 (w/w).

It is contemplated that different molar concentrations of HCl or alternatively an inorganic acid (mineral acid) may be substituted for the 1M HCl in the formulations of the present invention. For example, an alternative acid may be any pharmaceutically acceptable mono-or poly-acid, such as (but not limited to): hydrogen halides (hydrochloric, hydrobromic, hydroiodic, etc.), phosphoric acid, nitric acid, sulfuric acid, and haloketo acids (halogen oxyacids).

The pharmaceutically active ingredient of the composition is preferably completely and homogeneously dissolved in the mixture of propellant and co-solvent, i.e. the composition is preferably a solution formulation.

Optionally, the solution formulation may contain other pharmaceutical excipients or additives well known in the art. In particular, the compositions of the present invention may comprise one or more low volatility ingredients. Low volatility ingredients are useful to increase the Mass Median Aerodynamic Diameter (MMAD) of aerosol particles on actuation of the inhaler and/or to improve the solubility of the active ingredient in the propellant/co-solvent mixture.

The low volatility component has a vapor pressure at 25 ℃ of less than 0.1kPa, preferably less than 0.05 kPa. Examples of low volatility components may be esters such as isopropyl myristate, ascorbyl myristate, tocopheryl esters; glycols, such as propylene glycol, polyethylene glycol, glycerol; and surfactants such as saturated organic carboxylic acids (i.e., lauric, myristic, stearic) or unsaturated carboxylic acids (i.e., oleic or ascorbic).

The amount of low volatility component may vary between 0.1-10% w/w, preferably 0.5-5% (w/w), more preferably 1-2% (w/w).

In one embodiment, water in an amount of 0.005-0.3% (w/w) may optionally be added to the formulation to advantageously affect the solubility of the active ingredient without increasing the MMAD of the aerosol droplets upon start-up.

Advantageously, the formulation of the invention contains no other excipients (e.g. surfactants) other than the co-solvent, propellant and stabilizing amount of acid.

The pharmaceutical compositions of the invention may also comprise other additional pharmaceutically active ingredients for separate, sequential or simultaneous use. The optional additional pharmaceutically active ingredients of the composition include any pharmaceutically active ingredient known in the art for the prevention or treatment of respiratory diseases and symptoms thereof. Examples of such active ingredients are: beta-agonists, such as formoterol, salbutamol, fenoterol, carmoterol (TA 2005), indacaterol, miwiterod, vilanterol (GSK 642444), terbutaline, salmeterol, bitolterol and metaproterenol, in the form of their single stereoisomers or mixtures thereof and salts thereof; corticosteroids such as beclomethasone dipropionate, fluticasone propionate, butencort, mometasone furoate, triamcinolone acetonide, budesonide and its 22R-epimer, ciclesonide, flunisolide, loteprednol and rofleponide; other antimuscarinic agents such as scopolamine, ipratropium bromide, oxitropium bromide, and tiotropium bromide; phosphodiesterase IV inhibitors, such as cilomilast, roflumilast and tetomilast.

In a preferred embodiment, the composition of the invention comprises Beclomethasone Dipropionate (BDP) as active agent together with formoterol and glycopyrronium chloride components. In this embodiment, preferably BDP is present in the formulation in an amount of 0.07 to 0.41% w/w, preferably 0.1 to 0.3% w/w.

The compositions of the present invention may be inhaled from any suitable MDI device known to those skilled in the art. The desired dosage of each pharmaceutically active ingredient of the formulation depends on the nature of the ingredient and the type and severity of the disease, but is preferably such that the therapeutic amount of active ingredient is delivered in one or two actuations. Generally, the dosage of active ingredient will be about 0.5-1000. mu.g/actuation, such as about 1-100. mu.g/actuation, and sometimes about 5-50. mu.g/actuation. The person skilled in the art is well aware of how to determine suitable dosages for each pharmaceutical active ingredient.

For formoterol concerned, the preferred dose is about 0.5 to 50 μ g/actuation, preferably about 1 to 25 μ g/actuation, more preferably about 5 to 15 μ g/actuation. In specific embodiments, the dose of formoterol fumarate is about 6 or 12 μ g/actuation.

For glycopyrronium chloride involved, the preferred dosage is between about 0.5 and 100 μ g/actuation, preferably between about 1 and 40 μ g/actuation, more preferably between about 5 and 26 μ g/actuation. In a specific embodiment, the dosage of glycopyrronium chloride is about 25 μ g/actuation.

For beclomethasone dipropionate concerned, preferred dosages are between about 10 and 2000. mu.g/actuation, preferably between about 20 and 1000. mu.g/actuation, more preferably between about 50 and 250. mu.g/actuation. In specific embodiments, the dosage of beclomethasone dipropionate is about 50, 100, 200 μ g/actuation.

The pharmaceutical formulations of the present invention are infused into a pMDI device as is well known in the art. The apparatus comprises a tank fitted with a metering valve. Actuation of the dose valve enables a small portion of the aerosol product to be released.

Some or all of the can may be constructed of a metal such as aluminum, aluminum alloy, stainless steel, or anodized aluminum. Alternatively, the can may be a plastic can or a plastic-coated glass bottle.

The metal can may have an inner surface that is partially or fully lined with an inert organic coating material (coatings). Examples of preferred coating materials are epoxy-phenolic resins (epoxy-phenolic resins), perfluorinated polymers such as perfluoroalkoxyalkyl, perfluoroalkoxyalkenes, perfluoroolefins such as polytetrafluoroethylene (teflon), fluorinated-ethylene-propylene (FEP), Polyethersulfone (PES) or fluorinated-ethylene-propylene polyethersulfone (FEP-PES) mixtures or combinations thereof. Other suitable coating materials may be polyamide, polyimide, polyamideimide, polyphenylene sulfide, or combinations thereof.

In some embodiments, it may be preferable to use a can with an inner surface lined with FEP-PES or teflon.

In other embodiments, a canister constructed of stainless steel may be used.

The container is closed using a metering valve for delivering a daily therapeutically effective dose of the active ingredient. In general, a metering valve door component comprises a metal stiffener ring with an opening formed therein, a molded body connecting the metal stiffener ring housing a metering chamber, a stem consisting of a core and an extension of the core, inner-and outer-seals surrounding the metering chamber, a spring surrounding the core, and a gasket to prevent propellant from leaking through the valve.

The gasket seal or seals surrounding the metering valve may comprise an elastomeric material such as EPDM, chlorobutyl rubber, bromobutyl rubber, butyl rubber or neoprene rubber. EPDM rubbers are particularly preferred. The metering chamber, core and core extension are manufactured from a suitable material such as stainless steel, polyesters such as polybutylene terephthalate (PBT) or acetals. The spring is made of stainless steel, eventually comprising titanium. The metal reinforcement ring may be constructed of a metal such as aluminum, aluminum alloy, stainless steel, or anodized aluminum. Suitable valves are available from manufacturers such as Valois, Bespak plc and 3M-Neotechnic Ltd.

The pMDI is opened by a metering valve capable of delivering a volume of 25-100. mu.l, preferably 40-70. mu.l and optionally about 50. mu.l or about 63. mu.l per actuation.

Each filled canister is conveniently fitted with a multiplex device and then used to form a metered dose inhaler for administering the medicament into the lungs of a patient. Suitable multiplexing means include, for example, valve actuators and cylindrical or conical-like channels through which the drug can be delivered from a filled canister to the patient's mouth through a metering valve, such as a mouthpiece (mouthpiece) actuator.

In a typical arrangement, the valve stem is secured to a nozzle block having an orifice leading to an expansion chamber. The expansion chamber has an outlet that extends into the mouthpiece. Actuator (outlet) orifices having a diameter of 0.15-0.45mm and a length of 0.30-1.7mm are generally suitable. Preferably orifices having a diameter of 0.2-0.44mm are used, for example 0.22, 0.25, 0.30, 0.33 or 0.42 mm.

In some embodiments of the invention it may be used to use actuator orifices having a diameter of 0.10 to 0.22mm, in particular 0.12 to 0.18mm, such as those described in WO 03/053501. The use of fine orifices may also increase the duration of the formation of the dust mist (cloud) and may thereby facilitate the coordination of the formation of the dust mist with the slow inhalation by the patient.

In situations where water ingress into the formulation is avoided, it is desirable to overwrap the MDI product with a flexible packaging material that is resistant to water ingress. It is also desirable to have a material (e.g., molecular sieve) that can be incorporated into the package that is capable of adsorbing any propellant and co-solvent that may leak from the canister.

The MDI optionally filled with the formulation of the present invention may be used with suitable auxiliary means to facilitate proper use of the inhaler. Such auxiliary devices are commercially available and are referred to as "isolation chambers", "reservoirs" or "expansion chambers" depending on their shape and size. For example, volumic^TMIs one of the most widely known and used reservoirs, Aerochammber^TMIs one of the most widely used and known isolation chambers. Suitable expansion chambers are reported, for example, in WO 01/49350.

The formulations of the present invention may also be used with conventional pressurized breath-actuated inhalers, such as those known under the registered name Easi-breath^TMAnd Autohaler^TMThose of (a).

The efficacy of MDI devices is a function of the dose deposited at the appropriate location in the lungs. Deposition is influenced by the aerodynamic particle size distribution of the formulation and can be characterized by several parameters in vitro.

The aerodynamic particle size distribution of the formulations of the invention may be characterised using a Cascade impactor according to the method described in the european pharmacopeia 6 th edition 2009(6.5) 2.09.18. A device E operating at a flow rate of 30l/min to 100l/min or a device D-Andersen Cascade Impactor (ACI) -operating at a flow rate of 28.3l/min may be used. The deposition of drug on each ACI plate was determined by High Performance Liquid Chromatography (HPLC).

The following parameters of the particles emitted by pressurized MDI can be determined:

i) the Mass Median Aerodynamic Diameter (MMAD) is the diameter that approximates the mass aerodynamic diameter of the equally distributed emitting particles;

ii) calculating the delivered dose from the cumulative deposition in ACI divided by the number of activations per experiment;

iii) the absorbable dose (fine particle dose = FPD) was obtained from stage 3(S3) to deposition of filter (AF) of ACI (equivalent to particle diameter ≦ 4.7 microns), divided by the number of starts per experiment;

iv) absorbable fraction as a percentage between absorbable and delivered dose (fine particle fraction = FPF);

v) "ultra fine" dose obtained from stage 6(S6) to deposition of the filter (equivalent to particle diameter ≦ 1.1 microns), divided by the number of starts per experiment;

the solutions of the present invention are capable of providing greater than 40%, preferably greater than 50%, more preferably greater than 60% total FPF on actuation of a pMDI device in which they are contained.

Furthermore, the formulation of the present invention is capable of providing a fraction of emitted particles at start-up of greater than or equal to 30%, said emitted ions having a diameter of equal to or less than 1.1 microns, as defined by the capacity phase S6-AF of the Andersen Cascade impactor relative to the total fine particle dose collected in the S3-AF phase of the impactor. Preferably the fraction of emitting particles of diameter equal to or less than 1.1 micrometer is higher than or equal to 40%, more preferably higher than 50%, even more preferably higher than 60%, most preferably higher than 70%.

Another aspect of the invention provides a method of priming an aerosol inhaler with a composition of the invention. Conventional batch preparation methods and machines well known to those of ordinary skill in the art of pharmaceutical aerosol manufacture can be used to mass batch prepare commercially produced filled canisters.

The first method comprises the following steps:

a) preparing a solution of glycopyrronium chloride and formoterol fumarate and (optionally beclometasone dipropionate) in an optional co-solvent (e.g. ethanol), a mineral acid, a HFA-containing propellant and optionally low volatility ingredients at a temperature of-50 to-60 ℃, at which temperature the solution does not evaporate;

b) cold-filling the inhaler with the prepared solution; and

c) the valve was placed on the empty can and screwed (crimping).

Alternative selection methods include:

a) preparing a solution of glycopyrronium chloride and formoterol fumarate and (optionally beclometasone dipropionate) in a co-solvent (e.g. ethanol), mineral acid and optionally low volatility ingredients;

b) filling an open tank with the bulk solution;

c) placing the valve on the can and screwing; and

d) the canister was pressure-filled with HFA propellant through a valve.

Another alternative method comprises:

a) using a pressurized container to prepare a solution of glycopyrronium chloride, formoterol fumarate (and optionally beclometasone dipropionate) and an inorganic acid in an optional co-solvent (e.g. ethanol), optional low volatility ingredients and an HFA propellant;

b) mounting the valve on the empty can and screwing; and

c) the tank was pressure filled with the final solution formulation through a valve.

In one embodiment of the invention, oxygen is substantially removed from the headspace of the aerosol canister using conventional techniques to further stabilize the formoterol composition, especially at higher acid concentrations. This object can be achieved in different ways, depending on the method of filling the container. The cleaning can be done by vacuum screwing or, for example, by using a propellant (pumping). In a preferred embodiment, the second infusion method described above is modified to incorporate the oxygen scavenging step (c) by vacuum screwing.

The packaged formulations of the present invention are stable for extended periods of time when stored under standard temperature and humidity conditions. In a preferred embodiment, the packaged formulation is stable at 25 ℃ and 60% RH for at least 6 months, more preferably at least 1 year, most preferably at least 2 years. Stability was evaluated by measuring the content of residual active ingredient. As defined herein, a "stable" formulation refers to a formulation that retains at least about 85%, preferably at least about 90% and most preferably at least about 95% of the residual content of each active ingredient at the specified time point, as determined by HPLC-UV VIS.

The best stable formulation meets the specifications required for ICH Guideline Q1B or CPMP/QWP/122/02Rev.1 for drug product stability testing for drug registration purposes.

The combination product compositions of the invention may be used for prophylactic purposes or for therapeutic purposes or for symptomatic relief of a wide range of diseases and, therefore, in one aspect of the invention, relates to the use of any of these pharmaceutical compositions as a medicament. In particular, the combination product of the invention is useful for the prevention or treatment of a number of respiratory diseases, such as asthma of all types and Chronic Obstructive Pulmonary Disease (COPD).

Accordingly, in another aspect the present invention relates to a method of preventing or treating a respiratory disease, such as COPD, comprising administering to a patient in need of such treatment a therapeutically effective amount of a pharmaceutical composition of the present invention.

The invention also provides the use of the pharmaceutical composition of the invention in the therapeutic or palliative treatment or prevention of respiratory diseases and symptoms thereof.

Other respiratory diseases for which the use of the pharmaceutical compositions of the invention may be beneficial are those characterized by obstruction of the peripheral airways as a result of inflammation and the presence of mucus, such as chronic obstructive bronchiolitis, chronic bronchitis, emphysema, Acute Lung Injury (ALI), cystic fibrosis, rhinitis and adult or Acute Respiratory Distress Syndrome (ARDS).

Examples

1) Stability of single, dual and triple combination aerosol solution formulations

A study was conducted to investigate the stability of a combination of Formoterol Fumarate (FF), glycopyrronium chloride (GLY) and Beclometasone Dipropionate (BDP) in aerosol solution formulations in canister packs under variable storage conditions:

in addition to the triple combination, a double combination (FF + BDP; FF + GLY) and a single active agent (GLY) were included in this study to assess whether any possible interaction between the active ingredients could affect the stability of the drug. GLY was formulated as a single active with and without 1M HCl to evaluate the stabilizing effect of the acid.

The batch composition is summarized in table 1:

TABLE 1

The sample batches were stored in inverted orientation and under the following conditions and the contents of each checkpoint in both tanks were analysed (after 1,2 and 3 months of storage):

+5°C

+25 ℃ C./60% relative humidity (accelerated storage conditions)

+30 ℃ C/75% relative humidity

+40 ℃ C./75% relative humidity

The residual content of active ingredient was determined using standard chromatographic protocols.

Results

With the triple combination, BDP and GLY can contents were not significantly affected by time and temperature. Conversely, FF tank content is highly dependent on storage conditions: the% residue relative to 0 decreased with time and temperature.

When the formulations in triple combination were stored for 3 months at 25 ℃/60% relative humidity, the respective residual percentage of the active ingredient relative to its corresponding amount at 0 was determined and reported in table 2 below.

TABLE 2

Active ingredient	Residual% amount. + -. standard deviation	Number of cans (N.)
			FF	96.6±0.7	4
Gly	96.4±1.3	4
			BDP	94.5±0.3	4

For the dual combination of FF + GLY, the GLY component remained stable at all concentrations tested. As in the triple combination, the formoterol fumarate canister content is highly time and temperature dependent.

In contrast, the formoterol content of the FF + BDP dual combination did not decrease rapidly over time under any of the various storage conditions. These contrary observations lead to the following conclusions: the presence of GLY in combination with FF has the effect of destabilizing formoterol fumarate.

When the dual combined formulation was stored for 3 months at 25 ℃/60% relative humidity, the respective residual percentage amounts of the active ingredients relative to their respective amounts at 0 were determined and reported in table 3 below.

TABLE 3

Combination of	Active ingredient	Residual% amount. + -. standard deviation	Number of cans (N.)
				FF+Gly	FF	96.7±0.2	4
FF+Gly	Gly	96.0±0.1	4
				FF+BDP	FF	97.0±0.7	4
FF+BDP	BDP	98.9±0.6	4

It was found that a single active agent formulation comprising GLY maintained a constant level in the presence of 1M HCl, but was highly dependent on storage time and temperature if no acid was used. See table 4 below for data when single active agent formulations were stored for 3 months at 25 ℃/60% relative humidity with or without the same amount of acid.

TABLE 4

Active ingredient	Residual% amount. + -. standard deviation	Number of cans (N.)
			Gly (acid-free)	90.4±1.2	4
Gly (with acid)	94.4±0.2	4

2) Analysis of impurities/degradation products

All formulations protected at 25 ℃/60% RH were tested for achiral impurities and degradation products of the active ingredient by standard HPLC/UV VIS methods. MS detectors were used to confirm the molecular weight of the detected impurities/degradation products found in FF + BDP and FF + GLY + BDP tanks.

As a result:

those formulations containing both formoterol and GLY analyzed by HPLC/UV method have high degradation product levels related to formoterol fumarate. It was also observed that the amount of each degradation product increased with temperature.

When the formulations in triple combination were stored for 3 months at 25 ℃/60% relative humidity, the total percentage amounts of impurities and/or degradation products expressed relative to the initial amount of the corresponding active ingredients were determined and reported in table 5 below:

TABLE 5

Active ingredient	Relative to total impurities of the active ingredient%	Number of cans (N.)
			FF	1.1	2
Gly	0.75	2
			BDP	0.21	2

When the dual combined formulation was stored for 3 months at 25 ℃/60% relative humidity, the total percentage amounts of impurities and/or degradation products expressed relative to the initial amount of the respective active ingredients were determined and reported in table 6 below:

TABLE 6

Combination of	Active ingredient	Relative to total impurities of the active ingredient%	Number of cans (N.)
				FF+Gly	FF	1.3	2
FF+Gly	Gly	0.48	2
				FF+BDP	FF	0.80	2
FF+BDP	BDP	0.20	2

It was found that a single active agent formulation comprising GLY maintained a constant level in the presence of 1M HCl, but was highly dependent on storage time and temperature if no acid was used. See table 7 below for data on the amount of total percentage of impurities and/or degradation products expressed relative to the starting amount of active ingredient when a single active agent formulation is stored for 3 months at 40 ℃/75% relative humidity with or without the same amount of acid.

TABLE 7

Active ingredient	Relative to total impurities of the active ingredient%	Number of cans (N.)
			Gly (acid-free)	14.2	2
Gly (with acid)	1.0	2

3) Titration of acid content

Since the stability and impurity test results point to the importance of the acid in stabilizing formoterol fumarate in formulations in the presence of glycopyrronium chloride, a series of triple combination formulations were prepared with varying additions of 1M HCl between 0.191. mu.g/. mu.l and 0.254. mu.g/. mu.l. In each test sample pair, one can had oxygen removed by vacuum screwing to investigate the effect of oxygen on the degradation process.

After 3 months at 25 ℃/60% RH, the samples were analyzed for pot contents of active ingredients and major impurities/degradation products. The GLY and BDP components remained stable and hardly degraded within 3 months.

A comparison of those samples from which oxygen had been removed, it was observed that there was a consistent reduction in FF degradation as the acid content rose from 0.191 μ g/μ l to 0.222 and 0.234 μ g/μ l. The% degradation products at these acid values are below the drug registration identification/specification level.

In summary, based on the present results, a dual or triple combination comprising glycopyrronium chloride and formoterol fumarate (and optionally beclometasone dipropionate) can be optimally stabilized for clinical and commercial purposes by including 1M HCl in an amount of 0.191-0.254 μ g/μ l, preferably 0.22-0.23 μ g/μ l, in a solution formulation that has been depleted of net oxygen.

Claims (12)

1. A pharmaceutical composition comprising, dissolved in a mixture of an HFA propellant and a co-solvent:

(a) glycopyrronium chloride at a dose of 0.5-100 μ g/actuation; and

(b) formoterol or a salt thereof in a dose of 1-25 μ g/actuation;

to this composition 1M HCl has been added in an amount of 0.191-0.254. mu.g/. mu.l of the composition, wherein the co-solvent is ethanol.

2. The pharmaceutical composition of claim 1, further comprising one or more pharmaceutically active ingredients selected from the group consisting of beta agonists selected from the group consisting of salbutamol, fenoterol, carmoterol, indacaterol, mevalonate, vilanterol, terbutaline, salmeterol, bitolterol, metaproterenol, and salts thereof, an antimuscarinic agent, and a phosphodiesterase IV inhibitor.

3. The pharmaceutical composition of claim 2, wherein the corticosteroid is beclomethasone dipropionate.

4. The pharmaceutical composition of any one of claims 1-3, comprising:

(a) glycopyrronium chloride at a dose of 5-26 μ g/actuation; and

(b) the dose of formoterol or salt thereof is 5-15 mug per actuation.

5. The pharmaceutical composition of any one of claims 1-3, comprising:

(a) glycopyrronium chloride at a dose of 25 μ g/actuation; and

(b) formoterol or a salt thereof at a dose of 6 or 12 μ g/start.

6. The pharmaceutical composition of claim 3, wherein the dosage of beclomethasone dipropionate is between 50 and 250 μ g/actuation.

7. The pharmaceutical composition of claim 1 which has been depleted of oxygen.

8. An aerosol canister comprising the pharmaceutical composition of any one of claims 1 to 7.

9. The can of claim 8, the headspace of which has been depleted of oxygen.

10. A method of filling a canister as claimed in claim 8 or claim 9, comprising the steps of:

(a) preparing a solution of glycopyrronium chloride, formoterol fumarate and optionally beclometasone dipropionate in a co-solvent to which 1MHCl has been added in an amount of 0.191 to 0.254 μ g/μ l of the final solution, wherein the co-solvent is ethanol;

(b) filling an aerosol canister with the solution;

(c) the valve was placed on the can and vacuum tightened; and

(d) the canister was pressure-filled with HFA propellant through a valve.

11. A kit comprising a pharmaceutical composition according to any one of claims 1 to 7 and further comprising one or more pharmaceutically active ingredients for separate, sequential or simultaneous administration, wherein the pharmaceutically active ingredient is selected from the group consisting of beta agonists selected from albuterol, fenoterol, carmoterol, indacaterol, mevalon, vilanterol, terbutaline, salmeterol, bitolterol, metaproterenol and salts thereof, an antimuscarinic agent and a phosphodiesterase IV inhibitor.

12. Use of a pharmaceutical composition according to any one of claims 1 to 7 in the manufacture of a medicament for the prevention or treatment of asthma and chronic obstructive pulmonary disease.